HomeMy WebLinkAboutBuilding Permit Application i
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED j, l
Date: Permit Number:;' " OI
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Building Permit Application
Planning and Development Services I'
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 - Fax: (772)462-1578 Commercial Residential
.PERMIT APPLICATION FOR:
P P(}SE[?�1 tt 10EN E IT I.UCATION =a . -,
Address: 2J O IG N-- i Lie v 0,/-
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Legal Description: ►13 �L l�S 6s1
Property Tax ID#: Lot No.
Site Plan Name: Block No.
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Project Name:
Setbacks Front Back: Right Side: Left Side:
SDE kll.l Q QE CRIPTION OF W413�C.���� � �� ��a�� � a� �� ,� W
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CCITRUCTI€ N IIEORIIAT(QN °� SF� ..
AdditionalW.
workto a per,orme under this permit—check all that appy:
Mechanical _Gas Tank _Gas Piping _Shutters f ! Windows/Doors
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L/Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Roo. 00 Utilities:.. _Sewer _Septic Building Height:
E[ /LESSEE, a CONTRACTOR: I �� 3
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Name d22C r D_::. Name: w
Address: �Z�`3 siq',:� '��ie a<.4 L)<— ;, Company: Gniy'Yi �{ r5i Vic, }Gr/3 G
City: i Re rG-z 't State: E(2 Address: 2 2zc r7 Go''r�rgc.1�e i=
Zip Code:3 Ll5 U b Fax: City: Dom; ,r, State:�c_
Phone No. 5`� Zip Code:°�2 `1_11c ` .r�"I'r 'ax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page( if different E-Mail e',.3. C +'A A i L
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from the Owner listed above) State or County License 2f3v ly X177
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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-SUR,,RLEMENTAL CONSTFtt�CT'.QN LIEN LAW II��QRIVIATICINM . � � � � 4
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit•to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws.or and covenants that may restrict or prohibit such .
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Ow r/Lessee/Contractor as Agent for Owner Sig ture of Contract(V/LiseTtotderContract /Li
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFCOUNTY OF o
The forgoing instrykient was acknowledged before me Thefggoing in ent was acknowledged before me
this day of 201 by this 11 day o 20a by
(Na e f person acknowledging) (Na of person acknowledging)
(..,,,JAgnatCe'6f Notary Public-State Florida) tgna re of Notary Public-Ste of Florida ) V
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Ain ni A INGRAM
v .�%
Commission No. Al. ASHAHNA INGRAM a�;� o. Notary Public State of Florida
w (Sea�j mmission No. Comm.Exp
�ea��2n,2018
Notary Public State of Flori a Vly
• My Comm.Expires Dec 20,2 98 �:�, o;; Commission#FF 177249
�' OQ'J ir.nalmotary Assn.
r sion IF rr i r rtw
REVIEWS FRONT � RVIS6R, ssn, LAMS VEG A I N SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014